Effectivity comparison between three different enamel remineralizing agent postfix orthodontic treatment

Abstract

Background: This study aims to compare the effectiveness of topical fluoride application, a toothpaste containing synthetic hydroxyapatite with one containing calcium sodium phosphosilicate (CSPS) in remineralizing enamel after the debonding process.

Material and methods: The study constituted experimental laboratory research incorporating posttest-only control group design. A metal bracket was placed on the buccal surface of 40 premolar teeth and immersed in artificial saliva. After 1 month, the bracket was debonded. The teeth were then randomly divided into four groups, namely (n = 6) the control group (C), the 1st treatment group (T1), the 2nd treatment group (T2), and the 3rd treatment group (T3). There was no treatment of C group. For the T1 group, topical application of fluoride was conducted. For the T2 group, toothpaste containing synthetic hydroxyapatite was applied by brushing the teeth twice a day. The same treatment was administered to the T3 group, but using a different toothpaste containing CSPS. After a treatment of 14 days, the T1, T2, and T3 groups were prepared before being observed with a scanning electron microscope (SEM). The SEM data were examined visually and scored using an enamel surface index (ESI), an enamel damage index (EDI), and an enamel remineralization index. The data obtained were analyzed by means of Kruskal-Wallis and Mann-Whitney tests. The statistical significance value was P< 0.05.

Results: A review of the ESI and IRE scores showed that, compared to the C group, all treatment groups recorded a significantly lower score, with T2 registering the lowest. With regard to the EDI scores, only the T1 group showed no significant difference to the C group.

Conclusions: Sensitive toothpaste containing synthetic hydroxyapatite and CSSP proved to be more effective in forming the remineralization layer on tooth surfaces compared to topical fluoride application. Key words:Calcium sodium phosphosilicate, debonding process, enamel remineralization, synthetic hydroxyapatite, topical fluoride application.

Figure 1

Formula.

Figure 2

(A) The appearance of a sample of the C group. (A1) At ×500 magnification, rough scratches (red circles) with deep and rough erosion were observed in the center of the sample. (A2) At magnification of ×5000, deep and rough erosion was clearly visible. (B) The appearance of a sample of the T1 group. (B1) At ×1000 magnification, erosion was still evident (red circles) although smaller and shallower than C group. (B2) At ×5000 magnification, smoother scratches were visible (red circle).

Figure 3

(A) The appearance of a sample of the T2 group. (A1) At ×500 magnification, fine lines were visible (red circle). (A2) At ×2000 magnification, a clearer picture was produced which indicates the lines were formed of remineralizing material deposit (red circle). (B) The appearance of a sample of the T2 group. (B1) At ×500 magnification, a shallow erosion with smooth rounded edges was visible (red circle). (B2) ×5000 magnification revealed scales (red circle).

Figure 4

The appearance of a sample of the T3 group. (A) At ×500 magnification, a remineralization layer was found to cover almost the entire tooth surface, although some erosion still could be detected (red circle). (B) Magnification of ×5000 could provide a clearer picture of scales (red circle) which caused the remineralization layer to appear rough.